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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date-08/09/2019_...W......._____._...._--_---_____ �._..............__�.___W <br />Name _.........Toy Lilla <br />���.,.,,.. Engineering <br />BPW Date 08/27/2019 Phone Extension 5920 <br />iwmwowmmmmmmmmmomamurrmmmmuwmmanwummummmiuwaur�nnwaaudw.mrrvwwrru�aNmimuwwamw!wanr aenemaenuwnwuuuww�rmromm mmmuwvmar i wmrmm��mm mm H of wavrm� <br />__ Required Priorwto Submittal to Board <br />BPW Attorney Attorney Name ............... <br />......... ..... .... .....____ .....__._ ........_ ......... ._............�. <br />Dept. Attorney 0 Attorney Name <br />Purchasing 1:1 <br />Check the Appropriate Item Type - <br />" Professional Services Agreement LJ Contract <br />Open Market Contract <br />E] <br />Amendment/Addendum <br />[] <br />Bid Opening <br />❑ <br />Bid Award <br />E] Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />Chg. Order, No. <br />0 Traffic Control <br />R Other: <br />Company or Vendor Name Walsh & Kelly, Inc. <br />New Vendor <br />MBE/WBE Contractor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Purpose/Description <br />All Submissions <br />LJ Proposal <br />0 Special Purchase, QPA <br />❑ Req. to Advertise <br />❑ Reject Bids/Quotes <br />® PCA <br />Resolution <br />Ease./Encroach <br />Yes" If Yes, Approved by Purchasing <br />No <br />❑ Title Sheet <br />❑ WBE Completed E-Verify Form Attached ❑ Nos <br />Civic Alleyway Repaving <br />118-110 <br />Complete Streets Transportation_ <br />404.1001.460.42.30 <br />$54,047.51 <br />_Project <br />Closeout <br />For Change Orders Only �.... - <br />Amount of ❑ Increase L.­­ _............................................. .. _.............. <br />Decrease <br />Previous Amount <br />Increase <br />% <br />e: <br />Current Percent of Change: <br />Decrease <br />/ <br />New Amount <br />$ <br />.........................°.° <br />Increase <br />% <br />Total Percent of Change: <br />Decrease <br />% <br />Time Extension Amount: <br />New Completion Date: <br />